1471, either, cat. 52
INCIDENCE OF EMBOLIC CEREBRAL INSULTS AFTER
PERCUTANEOUS TRANSAPICAL AORTIC VALVE REPLACEMENT
D.S. Ropers1, S. Ensminger2, R. Feyrer2, J. Ludwig1, A. Doerfler3, M. Arnold1
1
Department of Internal Medicine 2, 2Department of Cardiac Surgery, 3Department of
Neuroradiology, University of Erlangen, Germany
Background: Transcatheter aortic valve replacement is rapidly establishing itself as a
new therapeutic approach for aortic valve stenosis. While initial clinical results are
promising, it is unknown whether mobilization and embolization of calcified particles
may lead to cerebral ischemia. We assessed the rate of periprocedural embolic
ischemic brain injury during transcatheter aortic valve replacement in patients
undergoing transapical valve implantation.
Methods: 25 patients (10 male, 15 female, mean age 81±5 years, average log.
Euroscore 32±10%) scheduled for transapical aortic valve replacement due to
calcified aortic valve stenosis were included. All patients received a baseline cerebral
MRI scan. MRI was repeated within 7 days after valve implantation. The MRI studies
included axial diffusion weighted, T2 weighted, FLAIR-weighted and T2 gradient
echo sequences. Standardized clinical assessment of the neurologic status was
performed prior to aortic valve replacement and before discharge.
Results: Transapical aortic valve replacement was successfully performed in all
patients. In 17 patients (68%) new cerebral lesions have been detected while 8
patients showed a normal second MRI scan. 11 patients had up to five, while 6
patients had more than five new lesions. The pattern of distribution and morphology
were typical of embolic origin. Despite the high incidence of morphologically
detectable lesions only 4 of 17 patients with new cerebral insults showed clinical
neurologic alterations. Out of these patients only one suffered from a permanent
stroke.
Conclusion: New embolic ischemic cerebral insults have been detected in 68% of
patients after transapical valve replacement. However, clinical symptoms are rare and
usually transitory.